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Phase 2B > Examination of GI system > Flashcards

Examination of GI system Flashcards

1
Q

Overview of examination of GI system

A

Inspection

Palpation

Percussion

Auscultation

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2
Q

Before you begin what do you have to do?

A

Wash your hands

Introduce yourself

Explain what you would like to do and ask for permission

Ask patient have they any questions

Chaperone

Exposure

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3
Q

What do we do in inspection?

A

Inspect in a systematic manner – start from the end of the bed and work your way from the hands to the face, neck, chest then abdomen

Assess the bed space too! – look for drip stands, catheter bags, inhalers etc

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4
Q

What can we realise from the end of the bed?

A

Is the patient in obvious discomfort or distress?
- Pain
- Tachypnoeic
- Jaundiced/cyanosed

Body habitus
Check the observation chart
Check the fluid balance chart

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5
Q

Koilonychia is shown in what

A

Fe deficient anaemia

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6
Q

Leukonychia is seen in what?

A

hypoalbuminaemia, liver cirrhosis

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7
Q

What is nail clubbing seen in?

A

Nail clubbing – resp, cvs and GI conditions (crohns, UC, cirrhosis)

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8
Q

Causes of palmar erythema?

A

many causes, portal hypertension and cirrhosis in GI tract

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9
Q

What is dupuytrens contracture seen in?

A

alcoholism and liver disease

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10
Q

How do we look for a liver flap?

A

Ask patient to extend their arms out with palms up

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11
Q

How to look for jaundice?

A

Ask patient to pull down their eyelid

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12
Q

What is xanthelasma?

A

Eye skin things

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13
Q

Kayser - Fleischer rings are found in…

A

Wilsons disease

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14
Q

What can be found in the mouth?

A

Angular cheilitis - spots on side of mouth - Fe Deficiency
Glossitis - Swollen red tongue
Mouth ulcers - red spots in mouth

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15
Q

What is found on inspection of the chest?

A

Spider naevi
SVC distribution
Gynaecomastia
Supraclavicular lymph node

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16
Q

What to do on inspection of the abdomen?

A

Ask the patient to lie flat with their hands beside their sides

Describe any scars, stomas, lesions, masses or obvious signs

Comment on whether the abdomen is distended

Don’t forget to mention the presence of drains, catheters etc!

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17
Q

Description of abdominal scars

A

Rooftop
Hypochondrial
Upper midline
Lower midline
Paramedian
Gridiron
Pfannenstiel
Slide 24 on examination of GI system great picture

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18
Q

What to comment on for stomas?

A

Site

Type of bowel

Content

Type of Bag

19
Q

What are the different signs seen on the abdomen?

A

Cullens sign - bruises near belly button - pancreatitis
Grey’s- Turner sign- Bruises on the side of abdomen - pancreatitis
Caput medusa - portal hypertension

20
Q

How do we palpate the abdomen?

A

Get down to the patient’s level
Palpate superficially then deep in all 9 regions on the abdomen
Start with the region that is further away from the area that is painful
Palpate the liver, spleen and ballott both kidneys
Palpate for a bladder and abdominal aorta

21
Q

How do we palpate?

A

Hand flat over each area and flex at the MCP joints

Look at the patients face, not at your hand

22
Q

How do we palpate the liver?

A

Deep breaths
Palpating hand will feel liver pushed down by the diaphragm in inspiration
Liver can be palpated up to 1cm below the right costal margin on deep inspiration
Gallbladder not normally palpable unless enlarged

23
Q

What is Murphy’s sign?

A

Ask the patient to exhale

Place hand in right upper quadrant just below costal margin

Ask the patient to inhale

Is positive if the patient is sore/catches breath on inhaling and is possibly a sign of cholecystitis

24
Q

How do we palpate the spleen?

A

Not normally palpable unless enlarged
Can place left hand posteriorly and roll patient slightly towards you
Begin in the right iliac fossa
Advance towards the left costal margin

25
Q

How do we ballot the kidneys?

A

Anterior hand lateral to the margin of the rectus in the upper quadrant
Posterior hand in the costovertebral angle to lift the kidney up against the anterior hand
Lower pole right kidney may be palpable in thin people, left kidney rarely palpable

Slide 33 of examination of GI system

26
Q

Big spleen features

A

Can’t get above
Can cross the midline
Sometimes can feel a splenic notch
Moves down on inspiration
Cannot ballott the spleen

27
Q

Big Kidney features

A

Can get above
Doesn’t cross the midline
Doesn’t move on respiration
Ballotable

28
Q

Palpate the abdominal aorta

A

Aortic pulsation may be felt in a normal thin person

29
Q

Palpate for a distended bladder

A

The bladder is only palpable when it has >300ml of urine

The patient may describe the sensation of needing to pass urine on palpation of a full bladder

30
Q

What is Rovsing’s sign?

A

Palpation of the left iliac fossa results in pain in the right iliac fossa

Can indicate appendicitis

31
Q

Where is percussion found of the liver?

A

percuss downwards from superior border of 6th rib then upwards from umbilicus in midclavicular line

32
Q

Where is percussion found from the spleen?

A

percuss in the left anterior axillary line, lowest intercostal space, if changes from resonant to dull on inspiration then splenomegaly

33
Q

Where is percussion of the bladder found?

A

from pubic symphysis to umbilicus

34
Q

How do you examine shifting dullness?

A

Palpate abdomen at midclavicular line where you detect dullness and then move over to a different area of the patient to see if the dullness is shifting elsewhere

35
Q

What do you do on auscultation?

A

Listen for bowel sounds and describe them

Listen for aortic and femoral bruits

36
Q

How do we complete the examination? (ISHRUG)

A

Inguinal lymph nodes
Stools
Hernial Orifices
Rectal Examination
Urinalysis
Genitalia

37
Q

What do we do at the end?

A

Thank the patient

Ask them to redress

Wash your hands!

38
Q

How to do a per rectal examination?

A

Left lateral position with knees tucked up towards chest
Inspect the perianal area for any lesions
Insert a gloved well-lubricated finger
Assess anal tone
Assess rectum for stool or masses
Assess size and feel of the prostate
Check the gloved finger for blood after removing

39
Q

How do we examine the scrotum?

A

Inspection
Scrotal skin
Lie of the testis

Palpation
- Gentle pressure to palpate the testes, epididymis and cord

Transillumination
-using a pen torch

40
Q

How to differentiate between the causes of scrotal swellings?

A

Can I get above the swelling?

Can I identify a normal testis?

Is the swelling tender?

Does the swelling transilluminate?

41
Q

Scrotal swelling - Can i get above the swelling?

A

NO - (Not a true scrotal swelling)
Infantile hydrocele
Hernia

Yes - True scrotal swelling
(PROCEED TO NEXT QUESTION)

42
Q

Scrotal swellings - Can I identify a normal testis?

A

No -Testicular Tumour, Tense Hydrocele, Orchitis
Yes - NOT A TESTICULAR MASS
(PROCEED TO NEXT QUESTION)

43
Q

Does the swelling transilluminate in scrotum? (Normal testis)

A

No - Spermatocele
Epididymitis
Epididymal tumour
Tuberculous epididymitis

Yes - Epididymal Cyst
Cyst of the cord
Lax hydrocele

44
Q

Does the swelling transilluminate in scrotum? (NO Normal testis)

A

No - Testicular Tumour
Haematocele (smooth surface, history of trauma
Orchitis (tender)

Yes - Hydrocele

Phase 2B (16 decks)

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